To view this online go to:
BlackBerry users please scroll down for story text.


This Week's Headlines

News From ACFAS
Foot and Ankle Surgery
Practice Management
Health Policy and Reimbursement
Technology and Device Trends

News From ACFAS

Board Nominations Now Open

ACFAS Fellows who meet criteria for election to the Board of Directors are encouraged to submit a nomination application by October 1. Two 3-year director terms are open for nomination this year. The Nominating Committee will announce recommended candidates to the membership no later than October 27. Candidate information and ballots will be mailed to all voting members no later than December 11. Ballots must be returned to the ACFAS office by January 10, 2010. New officers and directors will take office during the ACFAS 2010 Annual Scientific Conference on February 24, 2010 in Las Vegas.

Read complete details on the recommended criteria for candidates and download the nomination application, using the web link below, or contact Executive Director Chris Mahaffey at 773-693-9300, Ext. 1305, Questions regarding eligibility criteria should be directed to Nominating Committee Chairman John M. Giurini, DPM at or 617-632-7071.

What’s New at ACFAS e-Learning?

New content is added frequently to the e-Learning offerings on The two latest additions are:

• Podcast: “Evaluation of Plantar Fasciitis Treatment” – Hear a panel of experts discuss their different approaches to treating heel pain, and what they do when that approach doesn’t work.

• Scientific Session: “Monday Morning Quarterback” – Every experienced surgeon enters a case with a pre-determined game plan, believing it will lead to a successful result. Panelists in this session present cases where the result was less than successful; they share planning insights and discuss what they learned.

Access these informative programs 24/7 using the web link, below.

Stay Up-to-Date with the Latest Research

Thanks to residents at St. Vincent Hospital – Worcester (Mass.) Medical Center, ACFAS members can easily stay up-to-date with research published in journals they might not usually see. The newest abstracts include:

• The Efficacy of Intra-Articular Hyaluronan Injection After the Microfracture Technique for the Treatment of Articular Cartilage Lesions

• Quality of Life and Disability in Patients with Treatment-Failure Gout

• The Effect of Thrombin Activation of Platelet-Rich Plasma on Demineralized Bone Matrix Osteoinductivity

• Targeted Ultrasound of the Fifth Metatarsophalangeal Joint in an Early Inflammatory Arthritis Cohort

Access these, as well as an archive of previous abstracts, using the web link below.

H1N1 Flu Precautions for Your Practice

The Centers for Disease Control (CDC) is predicting a widespread outbreak of the H1N1 (swine) flu this fall, and advises that clinicians take precautions against its spread.

ACFAS urges its members and their office staff to review the information CDC has developed for providers and adopt appropriate protocols to minimize possible spread.

Use the web link below to access the latest CDC guidelines and information.

Foot and Ankle Surgery

Fatty Muscle Atrophy: Prevalence in the Hindfoot Muscles on MR Images of Asymptomatic Volunteers and Patients With Foot Pain

Researchers in this study evaluated the prevalence and degree of fatty muscle atrophy in the abductor digiti minimi (ADM), flexor digitorum brevis (FDB), abductor hallucis (AH), and quadratus plantae (QP) muscles in 80 asymptomatic volunteers and 80 patients with foot pain using magnetic resonance imaging. The found that the prevalence of fatty muscle atrophy of the ADM muscle—classically considered to represent entrapment neuropathy—is between 4 percent and 11 percent in both asymptomatic volunteers and patients with foot pain, and it increases with age.

From the article of the same title
Radiology (08/06/09) Schmid, Daniel T.; Hodler, Juerg; Mengiardi, Bernard; et al.

Managing Children's Anxiety Before and After Surgery

Experts have estimated that as many as 50 percent of children who undergo general anesthesia have mental distress after surgery that may include night terrors and longer-lasting emotional issues. Zeev Kain, MD, of the University of California Irvine published a study in the journal Anesthesiology looking at the use of melatonin prior to surgery. Each year, surgery is performed on more than 3 million children two to eight years of age, 25 percent of whom have an episode of post-operative hysteria, or "emergence delirium," after being under general anesthesia. According to Kain's research, among children who received melatonin before the operation, that number fell to about 5 percent. Post-operative hysteria can lead to development or behavioral changes that could include nightmares, bed-wetting, and separation anxiety, Kain said, so measures must be taken to alleviate children's trauma and parental anxiety.

From the article of the same title
Medical News Today (08/26/09)

Practice Management

Increase Your Profits With Better Coding

Medical practices must make correct coding and billing a priority to maximize their earnings. Stephen L. Cheng, an orthopedic surgeon at Kaiser Permanente in Cleveland, requires medical coders in his organization be certified by the American Academy of Professional Coders or by the American Health Information Management Association. He says that coders and physicians regularly collaborate to fine-tune the coding “pick-lists” used by the practice's electronic health record (EHR) system. He also notes that EHR can undercode or up-code, so coders must be vigilant in noting, correcting and informing physicians about inaccurate EHR recommendations.

From the article of the same title
Medical Economics (08/21/09) Bernard, Sheri Poe

Simple Internet Tools for Improving Healthcare

Danny Sands, a practicing physician and director at Cisco's Internet business solutions group, says doctors can embrace simple online tools to boost healthcare. Physicians, says Sands, have been slow to embrace social networking sites and even e-mail as a means of communicating with patients. While some doctors communicate with each other on a social networking site called Sermo, many have eschewed such sites for communications with patients over authentication concerns.

Microblogging services that give users more fine controls over who reads which messages might be quite suitable, says Sands. They could allow physicians to distribute health alerts and advice to all their patients or to set up separate accounts for patients with similar conditions. Or patient could have an individual portal page, where their physicians could share information and the patient could log in to see documents, test results, video chats, and other communications.

From the article of the same title
InformationWeek (08/26/09) Wagner, Mitch

Health Policy and Reimbursement

Employer-Sponsored Health Insurance Premiums Increase 119 Percent From 1999-2008; Projected to Double Again by 2020

Family premiums for employer-sponsored health insurance increased 119 percent between 1999 and 2008 nationwide and could increase another 94 percent to an average $23,842 per family by 2020 if cost growth continues unchecked, according to a new report by Commonwealth Fund. The report finds that national reforms that slow health care cost increases by 1 percent annually would yield more than $2,500 in reduced premiums for family coverage by 2020, while reducing growth by 1.5 percent would yield more than $3,700 in premium savings.

From the article of the same title
Commonwealth Fund (08/20/09)

Getting Cheaper, Better Healthcare at Home?

Increased use of house calls may help improve medical treatment while lowering costs. By staying in close touch with their sickest patients through home visits, supporters say, physicians can avoid admitting them to hospitals, where costs and complications can multiply. Currently, approximately 10 percent of Medicare beneficiaries, most suffering from multiple chronic conditions, account for nearly two-thirds of Medicare spending.

A team of four doctors and five nurse practitioners from the Virginia Commonwealth University (VCU) Medical Center, is participating in a house call initiative. They see approximately 275 homebound patients who live within 15 miles of the hospital in Richmond. Most of the patients suffer from multiple chronic conditions, and all are so ill that it has become an ordeal to go to the doctor's office for a routine physical or to check on a symptom. An internal analysis by VCU Medical Center suggested that from 2003 to 2006, the house call program helped cut the number of days these patients spent in the hospital by 50 percent, saving the medical center as much as $2 million. The U.S. Department of Veterans Affairs, which has operated a house call program since 1972, found in a separate study that their program cut hospital inpatient admissions by more than 25 percent and reduced total days of hospitalization by more than two-thirds.

From the article of the same title
Los Angeles Times (08/25/09) Levey, Noam N.

Healthy San Francisco Rates High in Satisfaction

According to a new study by the Kaiser Family Foundation, 94 percent of participants in San Francisco's universal health care program are at least somewhat satisfied with it and 92 percent would recommend it to a friend and think other cities should create similar programs. Forty percent said their care was considerably better since joining the program. Healthy San Francisco began in July 2007 to offer care to the city's more than 60,000 uninsured residents. It now covers about 75 percent of uninsured residents at a cost of roughly $120 million a year, including city money, state grants, employer contributions and participants' fees.

From the article of the same title
San Francisco Chronicle (08/26/09) Knight, Heather

State Site Has Data on Healthcare Costs

Minnesota has become the first state to launch a "one-stop comparison shopping Web site" that lists the average price paid by health insurance plans for 100 of the most common medical procedures. The price-comparison Web site,, expands on a four-year-old nonprofit site that reports quality measurements for health care providers. Private health plans provide the price and quality data used in the site.

From the article of the same title
St. Paul Pioneer Press (08/26/09) Salisbury, Bill

Technology and Device Trends

Effects of Foot Orthoses on the Work of Friction of the Posterior Tibial Tendon

Posterior tibial tendon dysfunction is a significant contributor to flatfeet. Non-operative treatments, like in-shoe orthoses, have varying degrees of success. Researchers in this study examined changes to the work of friction of the posterior tibial tendon under three conditions: intact, simulated flatfoot, and flatfoot with an orthosis, hypothesizing that work of friction of the posterior tibial tendon would significantly increase in the flatfoot yet return to normal with an orthosis. They concluded that the prefabricated orthosis did not consistently restore normal work of friction, though it did correct the flatfoot visually, implying that patients with flatfeet may be predisposed to developing posterior tibial tendon dysfunction due to abnormal gliding resistance, though bone orientations are restored.

From the article of the same title
Clinical Biomechanics (08/09) Hirano, Takaaki; McCullough, Matthew B. A.; Kitaoka, Harold B.; et al.

Improved Bracing Compliance in Children With Clubfeet Using a Dynamic Orthosis

Noncompliance with foot abduction bracing in children with clubfeet treated with the Ponseti method is the leading risk factor for deformity recurrence. A dynamic foot abduction orthosis is believed to result in improved compliance, fewer skin complications, and fewer recurrences. Researchers in this study compared a prospective cohort of children with idiopathic clubfoot using a dynamic brace to a historical control group treated with a standard orthosis. They found that dynamic foot abduction brace results in improved compliance, fewer recurrences, fewer skin complications, and reduced rates of surgery in idiopathic clubfoot than the traditional brace after non-operative correction with the Ponseti method.

From the article of the same title
Journal of Children's Orthopaedics (08/01/09) Vol. 3, No. 4, P. 271; Garg, Sumeet; Porter, Kristina

The Use of Botulinum Type A Toxin in the Treatment of Idiopathic Clubfoot: 5-year Follow-up

Researchers in this study report the five-year outcomes of a cohort of 44 patients with 65 idiopathic clubfeet treated with manipulation, casting, and Botulinum toxin A (BTX-A). Idiopathic clubfeet treated with BTX-A continued to show good outcomes at two to five-year follow-up, say the researchers. The conclude that BTX-A has been proven effective in the initial correction and continued management of idiopathic clubfoot.

From the article of the same title
Journal of Pediatric Orthopaedics (09/01/09) Alvarez, Christine M.; De Vera, Mary A.; Chhina, Harpreet; et al.

Abstract News © Copyright 2009 INFORMATION, INC.
Powered by Information, Inc.

You have received this newsletter as a service of the American College of Foot and Ankle Surgeons. To change your email address, please click here. If you wish to unsubscribe click here.
September 2, 2009